Implementation of the 'Countdown to Theatre' Approach to Bridge the Evidence-Practice Gap in Paediatric Preoperative Fasting: A Quality Improvement Initiative.

This was a single centre quality improvement project with no control group or randomisation, so the observed changes may reflect time, selection, other workflow changes or local culture rather than the intervention alone. The intervention was delivered as a bundle: the Countdown to Theatre schedule, moving fluid offering to bedside nurses, co-designed guidance, in-service education, emails, printed materials, posters and support rounds; the study cannot separate the contribution of any one component. The authors state that statistical significance was not measured for the fasting trend and that none of the risk or odds ratios achieved statistical significance, so the findings are descriptive temporal trends. Patient experience data were collected only before and immediately after implementation, and the postimplementation survey sample was too small for definitive conclusions; follow-up surveys at 3 and 6 months were not done because of funding limitations. Adherence remained incomplete: about 40% of patients still fasted for more than 6 hours, and the paper did not determine why. Encounters were excluded if key data for calculating fasting duration were missing, which may affect generalisability. The intervention was tailored to local workflows and culture at Queensland Children's Hospital, so it may not translate to other hospitals.

The authors declared no conflicts of interest, and the research received no external funding.

Do not conclude that giving nurses responsibility alone reduced fasting. The intervention was a bundle with co-designed guidance, education, posters and support rounds, and there was no control group. The study also did not test whether the fasting change was more than chance.